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ARCHIVED REPORTS XR0004302
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3500 - Local Oversight Program
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PR0544686
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ARCHIVED REPORTS XR0004302
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Entry Properties
Last modified
7/23/2019 11:53:14 AM
Creation date
7/23/2019 11:24:27 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
ARCHIVED REPORTS
FileName_PostFix
XR0004302
RECORD_ID
PR0544686
PE
3528
FACILITY_ID
FA0000916
FACILITY_NAME
7-ELEVEN INC #19976
STREET_NUMBER
1399
Direction
N
STREET_NAME
MAIN
STREET_TYPE
ST
City
MANTECA
Zip
95336
APN
21633034
CURRENT_STATUS
02
SITE_LOCATION
1399 N MAIN ST
P_LOCATION
04
P_DISTRICT
003
QC Status
Approved
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EHD - Public
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i <br /> Chain of Custody Number <br /> SECOR Chain-of Custody Record <br /> Field Office 077 Sacramento E2 Additional documents are attached, and are part of this Record <br /> Address 3017 Kilgore Road,Suite 100 Job Name 7-Eleven Store#19976 <br /> Rancho Cordova,CA Location 1399 North Main Street <br /> Manteca,California <br /> i <br /> Project# 77EL.19976.43 Task# 0410 Analysis Request <br /> Project Manager Jaff Auchterlonie <br /> Laboratory _KIff Analytical - <br /> Turnaround Time Standard :w N 12 <br /> IL y 2 m m m0.0 <br /> ui m <br /> W R m V o c <br /> Sampler's Name Danielle Ca Ian-W ht <br /> Sampler's Signature o m s N e'o a o .9 � iu �° Z <br /> o �� v dm do int �co ° a <br /> Sample ID Date Time Matra = 0. o a o o Q d o a o a Comments/ <br /> h ~ °° ~ a `° ' '� `° �' �' w W Instructions z' <br /> IJ e 05/27/03 2V53 Soil X X I X <br /> .� ,V <br /> I <br /> Special Instructlons/Comments Relin uished by Received by Sample Receipt <br /> 5 Oxygenates:TAME,MtBE, EtBE,TBA, & DIPE Sign ign Total no of containers <br /> email results to jauehterlonlef�secor com Print Danielle Catlin-Wri ht Print Chain of custody seats <br /> cC results to, dacatlln@secor com Company SECOR Company Rec'd in good condition/cold <br /> Time Datetm' o~ Time Date Conforms to record <br /> Relinquished by Received by <br /> Sign Sign Client SECOR <br /> Print Print Client Contact Jaff Auchterlonie <br /> Company Company Kiff Analytical Client Phone X16)861-0430 <br /> Time Date Time Date OS a ext.223 <br /> ssoai+cusr�c r�am — <br /> Date 5127103 Page 1 of 1 <br />
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